While the country debated the future of health-care reform last summer, employers wrestled with what to do about the soaring costs of providing health insurance for their employees. The average cost of a family policy offered by an employer rose 119% between 1999 and 2008, according to the Kaiser Family Foundation.
So, inevitably, employers are looking for ways to shift more of the burden to employees by raising premiums and out-of-pocket costs. But by making high-deductible policies a better deal and beefing up incentives to get employees to participate in wellness programs, employers are also encouraging employees to control their own health-care expenses. With that in mind, be prepared for some big changes when you get your open-enrollment packet this fall.
Higher premiums for dependents. Most employers still pay the bulk of health-insurance costs for their employees -- on average, about 80% of the premium, says Ron Cornwell, a consulting actuary with Milliman, a benefits consulting firm. But employers have gradually been scaling back subsidies for employees' family members. They now pay an average of just 67% of a family premium, leaving you to pick up the remaining 33%, says Cornwell.
What you can do. It may still be cost-effective for you to remain on your employer's policy. But investigate other options for your family. If your spouse has health coverage at work, compare the cost of keeping family members on your policy with the cost of shifting them to your spouse's plan. Also look into how much it would cost to buy an independent policy for your spouse and children. If they are relatively healthy and you live in a state with a competitive health-insurance marketplace (most states other than New York and New Jersey), that might be your best bet.
The strategy worked for Fernando and Amelia Robledo of Dallas. Fernando, an electronics technician, has coverage that is completely paid for by his employer. Amelia, who works at a children's hospital, also has good coverage through her employer. But when their son, Alexander, was born in August 2008, they discovered that they'd have to pay $300 per month to add him to Fernando's policy, and that it would cost even more to add him to Amelia's.
"The human-resources person at my job said that if we looked on our own, we could find insurance that's a lot cheaper for our son," says Fernando. "She was being honest with me, and she was right."
The Robledos shopped for policies at eHealthInsurance.com and found a Humana policy for Alexander that cost just $94.61 per month with a $5,000 deductible. Despite the high deductible, the policy covers all of Alexander's well-baby visits, immunizations and other preventive care -- and the Robledos pay only $35 for each of the first six doctor visits that aren't for preventive care. Before they found the Humana policy, each visit cost the Robledos $150.
Higher out-of-pocket costs. Many employers are modifying the way they cover prescription drugs and doctor visits by switching from co-payments to coinsurance. With co-pays, you pay a fixed amount for every doctor visit or prescription, such as $10 for a generic drug and $35 for a brand-name drug. With coinsurance, employees pay a percentage of the overall cost -- for example, 10% for a generic drug and 25% for a brand-name medication.